Laparoscopic lumbar arteries ligation for correction of a post-endovascular aortic repair type 2 endoleak

Endovascular aneurysm repair (EVAR) is increasingly used for abdominal aortic aneurysms repair. Type 2 endoleak (T2E) is a late complication. Endovascular techniques are usually considered as a first-line treatment option for its repair, but success rate is low in the mid-term. Laparoscopic repair is a minimally invasive alternative that enables definite lumbar arteries ligation for inflow and outflow from aneurysmatic sac (AS). We present a case of a 78-year-old male with a T2E diagnosed 2 years after an EVAR was performed for infra-renal AAA correction. Due to T2E persistence and AS growth, patient was proposed for repair. Surgery was considered the best option. Patient was submitted laparoscopic lumbar arteries ligation (LLAL) for correction of a post-EVAR T2E. Post-operative period was uneventful. T2Es are a relatively frequent late-complication after EVAR and, in certain circumstances, due to risk of rupture, repair is indicated. Endovascular embolization procedures can be done but recent evidence is less favorable to it. LLAL can be considered as a safe and feasible treatment in T2Es, with good midterm results. However, this is a technically demanding procedure that should be performed by experienced surgeons in high volume centers.